Growth and development - Preschool-age: Nursing

The preschool-age period lasts between 3 and 6 years of age, and is characterized by slow physical growth, but remarkable cognitive, language and psychosocial development compared to earlier stages. Preschool-age children are naturally inquisitive and start to explore and interact with the world around them. This ensures that they continue to learn all the skills that will lead to later success in the school age. Now, developmental psychologists involved in studying development during the preschool period include Jean Piaget, Erik Erikson, and Lawrence Kohlberg. Now let’s quickly take a look at two important terms here, which are growth and development. Growth refers to physical changes in height, weight, and the appearance of the body; whereas development refers to the acquisition of complex motor, cognitive, psychosocial, and moral skills, such as walking, speaking, turning a page in a book, understanding the concept of time, or smiling at familiar faces.

All right, when it comes to growth, preschool-age children gain an average of 6.5 to 7.5 cm each year, with an expected increase of 2.25 kg per year in weight. So, an average 5-year-old is about 110 cm tall and weighs about 18 kg. However, it’s important to note that children of the same age are frequently at different points in their growth during childhood. Other growth features include a slight increase in the length of the skull, with the lower jaw becoming more pronounced. The upper jaw also widens to make space for the emergence of permanent teeth, which usually start to appear at around 6 years of age. All right, let’s now take a quick look at the motor, cognitive, psychosocial, and moral development of preschoolers. Starting with motor development, this is a period where children improve their motor skills, and they become able to do certain things, like hold a good posture and tie their shoelaces. During preschool-age years, coordination, balance, and rhythm improve as well, allowing children to hop, skip, and run smoothly, and participate in a variety of sports.

Now, Piaget explains how the preschooler’s cognitive development is in the preoperational stage, meaning they tend to use symbols to represent words and ideas, which is why they tend to engage in symbolic or pretend play, called fantasy play, like playing dress-up; and they start developing magical thinking, and creating imaginary friends. At the same time, they can easily switch between fantasy and reality throughout the day. Preschool-age children may also attribute life-like characteristics to inanimate objects, the concept known as animism. They also begin showing interest in different toys such as puzzles, and displaying expressive creation skills with paints, paper, and crayons. During this period, preschoolers also become much more cooperative and engage in associative play with other preschoolers, where they play together while doing the same activity, like doing a puzzle together. Preschoolers should be able to count up to 10 or even more objects, can correctly name at least four colors, and know about things that are used in everyday life, such as home appli­ances, food, and money. By 6 years of age, they should have developed a vocabulary of about 2100 words, and be able to form a 6 word sentence.

Moving on to psychosocial development. According to Erikson, this is the period called initiative vs guilt, where children begin to take initiative by planning activities and developing new skills, which can give them a sense of accomplishment. However, if the preschooler is unable to accomplish these developmental tasks , or caregivers discourage these tendencies, children may develop a sense of guilt. In terms of moral development, Kohlberg places toddlers in the preconventional level of morality, where they continue to develop a sense of right and wrong; they start developing a conscience and adopting moral standards from their parents or other adults who influence them. They tend to adhere to those standards and behave obediently to gain rewards or avoid punishment. Toddlers also start to learn how to deal with anger, and problems like fighting with others, and lying. All right, now let’s switch the gears, and take a look at the physiologic changes that take place during the preschool years. Starting with the nervous system, its development enables improved coordination, such as being able to balance on one foot, as well as climb and descend stairs efficiently. Also, as more nerves in the spinal cord have become myelinated, there’s better bowel and bladder control, usually at 3 years of age.

Next, the respiratory system also continues to mature as the number of alveoli increases. Also, the respiratory rate decreases to about 16 to 22 breaths per minute. The Eustachian tube remains short, which makes it easier for pharyngeal germs to reach the middle ear, increasing the risk for otitis media. Changes in the cardiovascular system involve an increase in blood pressure and a decrease in heart rate. It’s important to note that on auscultation, preschoolers can present with an innocent murmur, mainly because the chest wall is thin enough to allow the heart to be close to the stethoscope. Regarding the gastrointestinal system, by the beginning of the preschool period, there are typically about 20 deciduous teeth. In addition, the small bowel length continues to increase, resulting in a decrease in stool frequency. Note that it’s important that preschoolers eat a nutritious and balanced diet consisting of a variety of different foods, to help support their ongoing growth. One model to help prepare a balanced diet is “MyPlate” food guide, which recommends vegetables and fruits to make up over half of the plate; and grains and proteins to occupy the other half of the plate, with grains taking a slightly larger portion. A balanced diet should also include dairy products, such as milk or yogurt, which provide the recommended daily amount of calcium. Major supplements may also be important, such as Iron-fortified cereals, vitamin D and C fortified juice, and fluoride for teeth reinforcement if the water is not fluoridated.